Nevin Manimala

JAMA Netw Open. 2022 Jul 1;5(7):e2223033. doi: 10.1001/jamanetworkopen.2022.23033.

ABSTRACT

IMPORTANCE: Opioid overdose is a leading public health problem in the United States; however, national data on overdose deaths are delayed by several months or more.

OBJECTIVES: To build and validate a statistical model for estimating national opioid overdose deaths in near real time.

DESIGN, SETTING, AND PARTICIPANTS: In this cross-sectional study, signals from 5 overdose-related, proxy data sources encompassing health, law enforcement, and online data from 2014 to 2019 in the US were combined using a LASSO (least absolute shrinkage and selection operator) regression model, and weekly predictions of opioid overdose deaths were made for 2018 and 2019 to validate model performance. Results were also compared with those from a baseline SARIMA (seasonal autoregressive integrated moving average) model, one of the most used approaches to forecasting injury mortality.

EXPOSURES: Time series data from 2014 to 2019 on emergency department visits for opioid overdose from the National Syndromic Surveillance Program, data on the volume of heroin and synthetic opioids circulating in illicit markets via the National Forensic Laboratory Information System, data on the search volume for heroin and synthetic opioids on Google, and data on post volume on heroin and synthetic opioids on Twitter and Reddit were used to train and validate prediction models of opioid overdose deaths.

MAIN OUTCOMES AND MEASURES: Model-based predictions of weekly opioid overdose deaths in the United States were made for 2018 and 2019 and compared with actual observed opioid overdose deaths from the National Vital Statistics System.

RESULTS: Statistical models using the 5 real-time proxy data sources estimated the national opioid overdose death rate for 2018 and 2019 with an error of 1.01% and -1.05%, respectively. When considering the accuracy of weekly predictions, the machine learning-based approach possessed a mean error in its weekly estimates (root mean squared error) of 60.3 overdose deaths for 2018 (compared with 310.2 overdose deaths for the SARIMA model) and 67.2 overdose deaths for 2019 (compared with 83.3 overdose deaths for the SARIMA model).

CONCLUSIONS AND RELEVANCE: Results of this serial cross-sectional study suggest that proxy administrative data sources can be used to estimate national opioid overdose mortality trends to provide a more timely understanding of this public health problem.

PMID:35862045 | DOI:10.1001/jamanetworkopen.2022.23033

JAMA Netw Open. 2022 Jul 1;5(7):e2223225. doi: 10.1001/jamanetworkopen.2022.23225.

ABSTRACT

IMPORTANCE: New-onset postoperative arrhythmia, which most often presents as postoperative atrial fibrillation (AF), is a frequent complication in patients undergoing visceral surgery of the upper gastrointestinal tract. Its relevance for patients’ outcomes is unknown.

OBJECTIVE: To assess the incidence of arrhythmia after upper gastrointestinal surgery, its risk factors, and its short- and long-term implications for patient outcomes.

DESIGN, SETTING, AND PARTICIPANTS: This cohort study included 1210 patients who underwent surgery of the upper gastrointestinal tract (esophagus, stomach, or pancreas) at the University Medical Center Göttingen in Germany between January 2012 and December 2018. Follow-up was performed between February and May 2020. Patients were excluded if they had a preexisting cardiac arrhythmia or pacemaker.

MAIN OUTCOMES AND MEASURES: The incidence of atrial fibrillation (AF) was recorded in most cases of postoperative arrhythmia; therefore, the analysis focused on postoperative AF. A multivariable logistic regression model was used to assess associations between surgical complications and postoperative AF occurrence, with odds ratios and 95% CIs reported.

RESULTS: A total of 1210 patients (median [IQR] age, 62 [19-90] years; 704 [58.2%] men) were enrolled in this study. Postoperative arrhythmia was recorded in 100 patients (8.3%). Among the different procedures, esophagectomy was associated with the highest incidence of postoperative AF (45.5% in complex esophageal resections and 17.1% in elective thoracoabdominal esophagectomies). The incidence of postoperative AF was associated with prolonged length of stay in the intensive care unit (23.4 days for patients with postoperative AF vs 5.9 days for those without; P < .001). Four factors were associated with the occurrence of postoperative AF: patients’ age (OR, 1.06; 95% CI, 1.03-1.08; P < .001), intraoperative surgical complications (OR, 2.47; 95% CI, 1.29-4.74; P = .006), infections (OR, 2.23; 95% CI, 1.31-3.80; P = .003), and organ failure (OR, 4.01; 95% CI, 2.31-6.99; P < .001). In the multivariable analysis, postoperative AF (OR, 7.08; 95% CI, 2.75-18.23; P < .001) and sepsis (OR, 10.98; 95% CI, 3.91-30.81; P < .001) were associated with in-hospital mortality. At a median 19-month follow-up, 20 of 74 patients (27.0%) with postoperative AF developed recurring episodes of arrhythmia after discharge.

CONCLUSIONS AND RELEVANCE: This cohort study found that the postoperative AF was associated with an increased length of stay in the intensive care unit and in-hospital mortality in patients after upper gastrointestinal tract surgery. In addition, postoperative AF was associated with development of permanent or paroxysmal arrhythmia after discharge.

PMID:35862044 | DOI:10.1001/jamanetworkopen.2022.23225

Hosp Pract (1995). 2022 Jul 21. doi: 10.1080/21548331.2022.2102777. Online ahead of print.

ABSTRACT

OBJECTIVES: Sleep disorders associated with COVID-19 pandemic are termed as “COVID-somnia”. In this study, we sought to assess the prevalence of COVID-somnia in healthcare workers, establish the factors that trigger this condition, and to investigate its relationship with anxiety and depression symptoms.

METHODS: This cross-sectional study was conducted between April 2021 and June 2021, and it included healthcare workers who served during the pandemic. Participants’ demographic data, Beck Depression and Anxiety Inventories, Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), and Insomnia Severity Index (ISI) were used, and the results were statistically analyzed. Multiple analyses of factors affecting ESS and ISI scores were evaluated using binary logistic regression model and PSQI score were analyzed using a multiple linear regression model.

RESULTS: A total of 1,111 healthcare workers who served during the pandemic voluntarily enrolled to the study. The mean age was 37.3 ± 8.48 years, and 63.5% were females. Our study showed that the healthcare workers, evaluated with the PSQI, experienced a deterioration of sleep quality. Primary factors affecting this are working on the front line, the presence of chronic diseases, depression, and anxiety. Regression analyses identified depression and anxiety as the common factors affecting ESS, ISI, and PSQI scores.

CONCLUSION: Raising awareness regarding COVID-somnia among healthcare workers, who play a leading role in curbing the pandemic, would reduce sleep disturbances, depression, and anxiety. It would also contribute to the planning and implementation of preventive and therapeutic mental health programs with a multidisciplinary approach.

PMID:35861139 | DOI:10.1080/21548331.2022.2102777

Clin Oral Implants Res. 2022 Jul 21. doi: 10.1111/clr.13983. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate the impact of reducing the radiographic field-of-view (FOV) on the trueness and precision of the alignment between cone beam computed tomography (CBCT) and intraoral scanning data for implant planning.

MATERIALS AND METHODS: Fifteen participants presenting with one of three clinical scenarios: single tooth loss (ST, n=5), multiple missing teeth (MT, n=5), and presence of radiographic artifacts (AR, n=5) were included. CBCT volumes covering the full arch (FA) were reduced to the quadrant (Q) or the adjacent tooth/teeth (A). Two operators, an expert (exp) in virtual implant planning and an inexperienced clinician, performed multiple superimpositions, with FA-exp serving as a reference. The deviations were calculated at the implant apex and shoulder levels. Thereafter, linear mixed models were adapted to investigate the influence of FOV on discrepancies.

RESULTS: Evaluation of trueness compared to FA-exp resulted in the largest mean (AR-A: 0.10 ± 0.33 mm) and single maximum discrepancy (AR-Q: 1.44 mm) in the presence of artifacts. Furthermore, for the ST group, the largest mean error (-0.06 ± 0.2 mm, shoulder) was calculated with the FA-FOV, while for MT, with the intermediate volume (-0.07 ± 0.24 mm, Q). In terms of precision, the mean SD intervals were ≤0.25 mm (A-exp). Precision was influenced by FOV volume (FA<Q<A) but not by operator expertise.

CONCLUSIONS: For single posterior missing teeth, an extended FOV does not improve registration accuracy. However, in the presence of artifacts or multiple missing posterior teeth, caution is recommended when reducing FOV.

PMID:35861131 | DOI:10.1111/clr.13983

Clin Oral Implants Res. 2022 Jul 21. doi: 10.1111/clr.13982. Online ahead of print.

ABSTRACT

OBJECTIVES: Optical impressions of implants in the edentulous arch are challenged by the absence of distinct surface morphology between multiple implant scan bodies. The purpose of this in vitro study was to evaluate a newly developed scan aid in various designs and colors to improve the accuracy of multi-implant scans.

MATERIAL AND METHODS: A universal scan aid in three different designs (circular, square, irregular) and three different materials (colors: beige, gray, white) was applied to the implant scan bodies of a master model of 6 implants in an edentulous maxilla. Ten scans using an intra-oral scanner of each scan aid were acquired. Reference scanning was performed using a desktop optical scanner. Alignment of scans was performed at the first scan body in a three-dimensional modeling and inspection software and deviations for trueness and precision were calculated using the signed nearest neighbor method and then statistically analyzed (α=.05).

RESULTS: Overall, the beige irregular scan aid had the highest trueness and showed significant differences compared to unsplinted scans. The precision showed more heterogenous results and decreased when using the scan aid. Ease of use was observed with the irregular gray scan aid due to its increased elongation at break.

CONCLUSIONS: The evaluated scan aid led to improved trueness when compared to unsplinted scans. Even though the irregular design in beige color showed highest trueness, the poor fracture strength of the tested material requires further improvement.

PMID:35861128 | DOI:10.1111/clr.13982

Clin Exp Allergy. 2022 Jul 21. doi: 10.1111/cea.14207. Online ahead of print.

ABSTRACT

It is increasingly recognised that children with asthma are at a higher risk of other non-allergic concurrent diseases than the non-asthma population. A plethora of recent research has reported on these comorbidities and progress has been made into understanding the mechanisms for comorbidity. The goal of this review was to assess the most recent evidence (2016-2021) on the extent of common comorbidities (obesity, depression & anxiety, neurodevelopmental disorders, sleep disorders and autoimmune diseases) and the latest mechanistic research, highlighting knowledge gaps requiring further investigation. We found the majority of recent studies from around the world demonstrates that children with asthma are at an increased risk of having at least one of the studied comorbidities. A range of potential mechanisms were identified including common early life risk factors, common genetic factors, causal relationships, asthma medication and embryologic origins. Studies varied in their selection of population, asthma definition and outcome definitions. Next steps in future studies should include using objective measures of asthma, such as lung function and immunological data, as well as investigating asthma phenotypes and endotypes. Larger complex genetic analyses are needed, including genome wide association studies, gene expression- functional as well as pathway analyses, or Mendelian Randomization techniques; and identification of gene-environment interactions, such as epi-genetic studies or twin analyses, including omics and early life exposure data. Importantly, research should have relevance to clinical and public health translation including clinical practice, asthma management guidelines and intervention studies aimed at reducing comorbidities.

PMID:35861116 | DOI:10.1111/cea.14207

Przegl Epidemiol. 2022;76(1):104-117. doi: 10.32394/pe.76.11.

ABSTRACT

INTRODUCTION: In 2020, the world was gripped by a global pandemic caused by a new strain of coronavirus called SARS-CoV-2. Highly contagious, rapidly spreading virus caused massive infections around the world and forced isolation of patients and quarantine of contact persons. Social isolation, caused by the introduction of compulsory distance or resulting from the course of the quarantine process, may result in the loss of emotional ties between individuals, thus leading to the weakening of the social support network.

OBJECTIVE: The aim of the study was to assess whether and to what extent the restrictions caused by the first wave of SARS-CoV-2 virus pandemics affected emotional state and everyday behavior of students of Polish universities.

MATERIAL AND METHODOLOGY: 1,095 students took part in the study – 82.1% of women and 17.9% men, aged 19 and over up to 55 years of age, living mostly in cities. The diagnostic survey method was applied using proprietary questionnaires. The questionnaire was distributed by Internet. The results were processed using the Statistica v.13.3 program with the application of descriptive statistics and tests χ2 and Anova.

RESULTS: According to 80% of respondents, the SARS-CoV-2 pandemic is a serious threat for health. During the first wave of the pandemic, students were accompanied mainly by difficult emotions: uncertainty (61%), depression (28.9%), worry (28.7%), nervousness (37.7%) and anger (24%). According to 50.2%, their relations with household members were not changed, while students declaring changes in family relationships pointed to their loosening and limitation.

CONCLUSIONS: A significant majority of students stated that the COVID-19 pandemic is a serious threat to health and has a regular interest in epidemiological data concerning coronavirus. Medical students declared the highest risk. The first wave of the pandemic resulted in the intensification of difficult emotions and for half of the respondents changes in the functioning of their family relationships.

PMID:35861098 | DOI:10.32394/pe.76.11

Acta Chim Slov. 2022 Jun 14;69(2):489-506. doi: 10.17344/acsi.2022.7427.

ABSTRACT

The present study deals with the in silico of 45 indolyl-aryl-sulfones known as anti-HIV1. The data were collected from recent previously reported inhibitors and divided into a sub-set of 33 compounds as the training set and the remaining 12 compounds were kept in the test set. The selected pharmacophore-ADRRR-yielded a statistically significant 3D-QSAR model containing high confidence scores (R2 = 0.930, Q2 = 0.848, and RMSE = 0.460). The predictive power of the established pharmacophore model was validated with an external test (r2 = 0.848). A systematic virtual screening workflow shows an enrichment factor and has revealed a high predictive power. Then the model was used to screen the filtered PubChem database mapping all chemical features of model pharmacophore. The recognized hits were further assessed by in silico ADMET studies. Molecular dynamics also used to explore the stability of obtained complexes. Finally, these selected compounds are probably to become a good lead molecule for the development of effective anti-HIV-1 drugs.

PMID:35861093 | DOI:10.17344/acsi.2022.7427

Int J Technol Assess Health Care. 2022 Jul 21;38(1):e62. doi: 10.1017/S0266462322000447.

ABSTRACT

OBJECTIVES: Web-based interventions for the promotion of maternal mental health could represent a cost-effective strategy to reduce the burden associated with perinatal mental illness. This study aimed to evaluate the cost-utility of Be a Mom, a self-guided web-based cognitive behavioral therapy intervention, compared with a waiting-list control.

METHODS: The economic evaluation alongside a randomized controlled trial was conducted from a societal perspective over a 14-month time frame. Postpartum women presenting low risk for postpartum depression were randomized to the intervention (n = 191) or control (n = 176) group and assessed at baseline, postintervention and 4 and 12 months after postintervention. Data regarding healthcare use, productive losses and quality-adjusted life years (QALYs) were collected and used to calculate incremental cost-effectiveness ratios (ICERs). Uncertainty was accounted for with nonparametric bootstrapping and sensitivity analyses.

RESULTS: At 14 months, and after accounting for a 3.5 percent discount rate, the intervention resulted in a yearly cost-saving of EUR 165.47 (-361.77, 28.51) and a QALY gain of 0.0064 (-0.0116, 0.0244). Bootstrapping results revealed a dominant ICER for the intervention group. Although results were statistically nonsignificant, cost-effectiveness acceptability curves showed that at a EUR 0 willingness to pay threshold, there is a 96 percent probability that the intervention is cost-effective when compared with the control group. The sensitivity analyses generally supported the acceptable likelihood of the intervention being more cost-effective than the control group.

CONCLUSIONS: From a societal perspective, the implementation of Be a Mom among low-risk postpartum women could be a cost-effective way to improve perinatal mental health.

PMID:35861012 | DOI:10.1017/S0266462322000447

Psicothema. 2022 Aug;34(3):392-401. doi: 10.7334/psicothema2021.411.

ABSTRACT

BACKGROUND: Family members of people with borderline personality disorder (BPD) are seriously affected by the disease and it is common for them to ask for professional help. The main objective of this study is to assess, in an open clinical trial, a treatment protocol based on Dialectical Behaviour Therapy (DBT) strategies for relatives of individuals with BPD, compared to the same protocol plus a mindfulness component (DBT-M).

METHOD: The interventions were conducted in a sample of 108 relatives of 83 patients diagnosed with BPD from a Specialized Unit for Personality Disorders. Relatives and patients completed the assessment protocol before and after the intervention.

RESULTS: Significant improvements in almost all the relevant variables tested were observed after the treatment in both the relatives and the patients. However, there were only statistically significant differences between the groups in the negative attitude towards the illness, where relatives in the DBT-M condition showed greater improvement than those in the DBT condition.

CONCLUSIONS: The results indicate that the intervention helps both patients and relatives to improve on key issues. It is essential to consider and offer support to the families of people with severe psychological disorders.

PMID:35861001 | DOI:10.7334/psicothema2021.411